Proposer's Full Name(s):(enter sole trader's name or all partner's names if a partnership)
Contact Name:(if different to proposer's name)
Limited Company Name:(if operating as a Ltd. company)
Trading Name:(if different to the above)
Trading Status:
- - - - - - - Please Select - - - - - - -
Sole Trader
Partnership
Private Limited Company (LTD)
Public Limited Company (PLC)
Limited Liability Partnership (LLP)
Pub Address:
Pub Postcode:
Is there a different correspondence address? Yes No
Correspondence address:(if different from the above)
Daytime Telephone No.
*E-Mail Address:
*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.
Have you, or any other partner or director ever been convicted of or charged with any criminal offence? Yes No
If yes, please provide details:(i.e. date of conviction, type of conviction, length of custodial sentence, etc.)
Have you, or any other partner or director ever had any County Court Judgements (CCJ's) / sheriff decrees or been declared bankrupt, or involved in a company which has become insolvent or which has gone into liquidation, receivership or administration? Yes No
If yes, please provide details:(i.e. date of bankruptcy/insolvency, amount of bankruptcy/insolvency, whether discharged/settled or not, etc.)
Have you or any other director ever been disqualified from being a director? Yes No
If yes, please provide details:(i.e. name of director, reason for disqualification, etc.)
Has any insurer ever refused, declined, cancelled or imposed special terms in respect of your pub insurance? Yes No
If yes, please provide details:(i.e. name of insurer, reason for refusal/special terms, etc.)
Have you, or any other partner or director ever been prosecuted or received notice of intended prosecution under the Consumer Protection Act, Food Safety Act, Health & Safety Act or similar legislation? Yes No
If yes, please provide details:(i.e. date of prosecution, reason for prosecution, etc.)
Can you confirm that you meet all the Statutory obligations; including fire safety, electrical inspections, Health & Safety and COSHH regulations, relating to the operation of your business? Yes No
Trade Description / Experience
What is your trade description?
Pub - Independent
Pub - Managed
Pub - Tenanted
Bar
Bar + Restaurant
Club
Inn
Wine Bar
Please state the number of years trading under current management:
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
20+
year(s)
If a new venture, please state the number of years previous experience (if applicable) :(A minimum of 3 years previous experience is required if you have 0 years trading)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
30+
year(s)
Is the pub open throughout the year?(i.e. not seasonal) Yes No
If no, please provide details:(i.e. period when it closed and is anyone living on the premises during this period?)
Is any part of the pub currently unoccupied? Yes No
If yes, please provide details:(i.e. what percentage of the pub is unoccupied, how long has it been unoccupied and when is it expected to be re-occupied?)
Is the property in a good state of repair and maintained? Yes No
Are you the sole occupant of the property?(i.e. not shared with any other businesses) Yes No
If no, please provide details of other occupants:
Pub Construction Details
Construction of Walls (e.g. brick, stone, etc.) :
Does the building contain any timber framed construction? Yes No
What percentage of the building is timber framed?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Construction of Roof (e.g. tile, slate, felt, thatch, etc.) :
If there any flat roofing? Yes No
Please confirm percentage Flat Roofing: %
Please confirm the type of flat roofing:(e.g. 'felt/bitumen on wood' or 'concrete flat roof')
Construction of Floors:
Both Wooden And Concrete
All Concrete
All Wooden
Other
Approximately, what year was the pub built? (yyyy)
Is the property a grade listed building?(i.e. grade I, II, etc.)
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
Has there ever been any flooding at the premises or nearby? Yes No
If yes, please provide details:(i.e. date of damage, amount of damage (£'s), type of damage, etc.)
Please indicate the distance to the nearest river, watercourse, canal, lake, sea, coast, etc.:(e.g. 250 metres)
Is there a basement or a cellar? Yes No
Heating
Are the premises only heated by fixed heating and not by any portable heaters? Yes No
If no, please provide details of portable heaters:(i.e. Number of portable heaters, type of portable heaters (e.g. fan heater, oil filled radiator, etc.)
Do the premises have open fires or wood burning stoves that are currently in use or will be during the year? Yes No
Entertainment
Do you have extended opening hours?(i.e. after 11pm) Yes No
If yes, please provide details:(e.g. days and times you stay open until)
Do you employ door supervisors? Yes No
Are they agency (sub-contract) SIA door staff only?(Agency staff only are acceptable; Directly employed or a combination of Agency only and Directly employed are not acceptable) Yes No
Is there any live entertainment at the premises?(e.g. Karaoke, disco's, bands, quiz nights, etc.) Yes No
Please confirm the type of entertainment:(e.g. Karaoke, disco, bands, quiz nights, etc.)
Please confirm the number of times per month the entertainment is held:(e.g. 4 times per month) per month
Is an entry fee ever charged at the door? Yes No
Is there a stage area? Yes No
Is there a dance floor area or an area routinely cleared to allow dancing? Yes No
Is the dance floor or area set aside for dancing located within a function room? Yes No
What is the approximate size of the dance floor?(e.g. 5 metres x 5 metres)
What is the maximum capacity of people on the dance floor area:(i.e. maximum number of persons on the dance floor)
Do you have a function room? Yes No
If yes, please confirm the type(s) of functions:(e.g. birthday parties, wedding parties, etc.)
Number of functions per month: per month
Do the premises have any children's play areas or bouncy castles? Yes No
If yes, please state the type of play equipment used:
Type of floor covering (if applicable):(e.g. bark chippings, foam mats, grass, etc.)
Security
Are all your external doors fitted with a minimum of 5 lever mortise deadlocks (BS3621) or equivalent? Yes No
Are all opening windows fitted with key operated window locks? Yes No
Is the pub protected by an intruder alarm? Yes No
If yes, is the alarm NACOSS / NSI approved?
Please Select
No
Yes
Not Sure
Method of intruder alarm signalling:
- - - - - - Please Select - - - - - -
Audible - Bells or Siren
Monitored - Central Station
Dialler - To Principal
BT REDCARE - To Central Station
Is the alarm maintained annually? Yes No
Do you have CCTV at the premises? Yes No
What level of CCTV coverage protects the premises?
Internal Only
External Only
Internal & External CCTV
External Local Authority CCTV
Own CCTV & Local Authority CCTV
Details of CCTV storage:
Live CCTV Only - Not Recorded
Recorded to Hard Disk - At Premises
Recorded to Hard Disk - Off Premises
Cloud Based Recording
How many days is the recording kept for?
Please provide details of any other security arrangements:(e.g. window grilles, etc.)
By whom are the premises occupied overnight?
Not Occupied Overnight
Proposer Living On Premises
Manager Living On Premises
Employees Living On Premises
Family Living On Premises
Private Tenant Living On Premises
Landlord Living On Premises
Other
Are the premises protected by a fire alarm? Yes No
If yes, type of fire alarm?
Audible / Bells Only
Central Station Monitored
Is the fire alarm maintained annually? Yes No
Is there an A.T.M. (cash machine) on the premises? Yes No
Seating Capacity
What is the approx. seating capacity of the premises?
Claims Experience
Have you, or any other director or partner (in this or any other trading name) suffered any loss or had any claims made against you in the last 5 years? Yes No
If yes, please provide details:(i.e. date of claim, amount of claim, description of claim, etc.)
Catering
Do you sell food for consumption at the premises?(e.g. bar meals, restaurant area, etc.) Yes No
What percentage of turnover is derived from food sales?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Please confirm whether or not you provide bar meals only or have a seperate restaurant:
Bar Meals Only
Restaurant Area Only
Bar Meals + Restaurant Area
Not Applicable
Do you carry out Deep Fat Frying? Yes No
If yes, please state type of frying equipment:
Shallow Pan Frying (incl. woks & frying pans)
Freestanding-6 litres capacity or less
Freestanding-10 litres capacity or less
Freestanding-40 litres capacity or less
Freestanding-More than 40 litres capacity
Full Frying Range
Is the frying equipment cleaned weekly? Yes No
Is any deep fat frying equipment fitted with a thermostat designed to prevent the temperature of oils/fat from rising above 205°C? Yes No
How often is the frying equipment competently serviced?
Every 6 months
Every 12 months
Less than every 12 months
Never
How often are the extraction systems and ducting cleaned by professionals?
N/A - No Ducting
Every 6 months
Every 12 months
Less than every 12 months
Never
Are the premises protected by kitchen fire suppression? Yes No
If yes, details of fire suppression system?(e.g. chemical foam, etc.)
Do you provide a takeaway food service? Yes No
If yes, percentage of turnover this represents:
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Accommodation
Do you provide accommodation?(e.g. bed & breakfast, overnight only, etc.) Yes No
If yes, please indicate the total number of guest rooms:
Please state the maximum number of guests:
Type of guests staying:
Overnight Only
D.S.S.
Bed and Breakfast
Other
Total Guests Effects Sum Insured (if cover is required) :
Standard cover is for Fire, Theft and Special Perils.(e.g. fire, theft, flood, storm, lightning, explosion, earthquake, impact by aircraft, escape of water, riot, etc.)
Do you wish to include Accidental Damage cover?(available at extra cost) Yes No
Is Terrorism cover required?(available at extra cost) Yes No
Buildings (if owner occupied and required)
Buildings Sum Insured (if required) :(reinstatement value including outbuildings and an allowance for demolition costs, removal of debris, rebuilding architects fees, etc.)
Is Subsidence, Heave or Landslip cover required?(available at extra cost) Yes No
Has the property ever previously been affected by subsidence? Yes No
If yes, please provide details of the claim:(e.g. date of claim, amount of claim (£'s), details of damage, etc.)
Tenants Improvements (if renting the pub and required)
Do you require Tenants Improvements cover?(i.e. to insure improvements you have made as a tenant to the building's fixtures & fittings such as a new counter, suspended ceiling, partitions, lighting, decorations, etc.) Yes No N/A
If yes, please state the sum insured:
Pub Contents / Fixtures & Fittings
Electronic Equipment & Computers Sum Insured:
All Other Pub Fixtures & Fittings / Contents Sum Insured:
Personal / Household Contents Sum Insured:(if required and you live at the property)
Stock
Wines and Spirits (excluding beer) :
Tobacco, Cigarettes & Cigars:
All Other Stock Sum Insured (including beer) :
Deterioration of Frozen Food
Deterioration of Frozen Food (if required) :
Glass & Signs
Fixed External Glass & Signs Sum Insured:
Money
Money Sum Insured:(during working hours / in transit)
£0
£500
£1,000
£2,000
£3,000
£4,000
£5,000
£6,000
£7,000
£8,000
£9,000
£10,000
Money Sum Insured:(out of working hours and in a safe)
£0
£500
£1,000
£2,000
£3,000
£4,000
£5,000
£6,000
£7,000
£8,000
£9,000
£10,000
Good In Transit
Goods In Transit Sum Insured (if required) :
Do you require Business Interruption cover?(i.e. loss of profit following an insured event such as a fire, etc.) Yes No
Please confirm the Annual Gross Profit of the pub:
Please advise the period of time you wish the cover to extend?(allow sufficient time for rebuilding/refurbishing and further time to resume normal trading) 12 months 24 months 36 months
Do you require cover for Loss of Liquor Licence?(i.e. depreciation of the value of the premises) Yes No
If yes, has there been any opposition to renewal or transfer of the licence in the last 5 years? Yes No
If yes, please confirm the sum insured required:
Do you require cover for Loss of Book Debts? Yes No
If yes, please indicate the maximum amount of Debit Balances outstanding at any one time:
Public / Product Liability limit of indemnity:
£1,000,000
£2,000,000
£5,000,000
Is there any manual work carried out away from the premises other than collection or delivery? Yes No
If yes, please provide details:(i.e. type of work and number of employees involved)
Do you require Employers' Liability cover?(£10 Million limit of indemnity) Yes No
If yes, please confirm total number of employees:
If yes, please confirm total wages of the employees: Per Annum
Employers' Reference Number (optional)
Employers' Reference Number (if available) : (e.g. 123/AB12345 or 'Exempt')
Turnover
Annual Turnover of your business (£'s):
Is Business Legal Expenses cover required?(£50,000 or £100,000 legal defence costs for contract disputes, employment disputes, VAT investigations, etc.) Yes No
Limit of indemnity required:
£50,000
£100,000
Has the business and/or its directors been involved in any legal dispute, tax investigation or any other court or tribunal action in the last 5 years? Yes No
Please provide details of the dispute including dates:
If there is any additional information that you wish to disclose or cover that you wish to include, please provide details:
You are required to make a fair presentation of the risk to insurers which means that you are required to disclose every material circumstance which you know or ought to know relating to the risk to be insured. Materially important information is any information that could influence an insurer's decision to accept your risk including the cost of your insurance. Failure to comply with the duty of fair presentation could mean that your policy is void or that insurers are not liable to pay all or part of your claim(s). By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.
Cover Start Date / Renewal Date:
Current Annual Premium / Best Quote to Beat: This may help us to get you a better quote
Name of Current / Previous Insurer: e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.